Magnitude of benefit of the addition of bevacizumab to first-line chemotherapy for metastatic colorectal cancer: Meta-analysis of randomized clinical trials

Fotios Loupakis, Emilio Bria, Vanja Vaccaro, Federica Cuppone, Michele Milella, Paolo Carlini, Chiara Cremolini, Lisa Salvatore, Alfredo Falcone, Paola Muti, Isabella Sperduti, Diana Giannarelli, Francesco Cognetti

Research output: Contribution to journalArticle

Abstract

Background: Although the addition of bevacizumab to 1st line chemotherapy provides a significant survival benefit for advanced colorectal cancer, the magnitudes of both advantages and toxicities have not been extensively investigated. Methods: A literature-based meta-analysis was conducted; Hazard Ratios were extracted from randomized trials for primary end-points (Progression Free Survival, PFS, Overall Survival OS). The log of event-based risk ratio were derived for secondary endpoints (objective/partial response rate, ORR/PR; severe hypertension, bleeding and proteinuria). Absolute differences and the number needed to treat/harm (NNT/NNH) were calculated. A meta-regression analysis with clinical predictors and a sensitivity analysis according to the trial phase-design were conducted as well. Results: Five trials (2,728 pts) were selected. The addition of bevacizumab to 1st line chemotherapy significantly increased both PFS (although with significant heterogeneity) and OS over exclusive chemotherapy by 17.1% and 8.6% (NNT 6 and 12), regardless of the study setting (non significant interaction between phase II and III). The chance to improve PR was significantly increased by 6.5% (NNT 15), with a trend for ORR. The risk of hypertension was significantly increased by 6.2% (NNH 16). According to the meta-regression analysis, female gender and rectal primary site were significant predictors for PFS benefit. Conclusions: Notwithstanding all the concerns related to costs and the significant HTN risk, the significant outcome improvement provided by bevacizumab in first-line treatment for unselected advanced colorectal cancer patients, should be considered when choosing the appropriate up-front therapy.

Original languageEnglish
Pages (from-to)58
Number of pages1
JournalJournal of Experimental and Clinical Cancer Research
DOIs
Publication statusAccepted/In press - May 26 2010

Fingerprint

Meta-Analysis
Colorectal Neoplasms
Randomized Controlled Trials
Drug Therapy
Regression Analysis
Hypertension
Numbers Needed To Treat
Survival
Proteinuria
Disease-Free Survival
Odds Ratio
Hemorrhage
Costs and Cost Analysis
Therapeutics
Bevacizumab

ASJC Scopus subject areas

  • Oncology
  • Cancer Research
  • Medicine(all)

Cite this

Magnitude of benefit of the addition of bevacizumab to first-line chemotherapy for metastatic colorectal cancer : Meta-analysis of randomized clinical trials. / Loupakis, Fotios; Bria, Emilio; Vaccaro, Vanja; Cuppone, Federica; Milella, Michele; Carlini, Paolo; Cremolini, Chiara; Salvatore, Lisa; Falcone, Alfredo; Muti, Paola; Sperduti, Isabella; Giannarelli, Diana; Cognetti, Francesco.

In: Journal of Experimental and Clinical Cancer Research, 26.05.2010, p. 58.

Research output: Contribution to journalArticle

@article{348d7ce213384a759f7001b80a7a7f05,
title = "Magnitude of benefit of the addition of bevacizumab to first-line chemotherapy for metastatic colorectal cancer: Meta-analysis of randomized clinical trials",
abstract = "Background: Although the addition of bevacizumab to 1st line chemotherapy provides a significant survival benefit for advanced colorectal cancer, the magnitudes of both advantages and toxicities have not been extensively investigated. Methods: A literature-based meta-analysis was conducted; Hazard Ratios were extracted from randomized trials for primary end-points (Progression Free Survival, PFS, Overall Survival OS). The log of event-based risk ratio were derived for secondary endpoints (objective/partial response rate, ORR/PR; severe hypertension, bleeding and proteinuria). Absolute differences and the number needed to treat/harm (NNT/NNH) were calculated. A meta-regression analysis with clinical predictors and a sensitivity analysis according to the trial phase-design were conducted as well. Results: Five trials (2,728 pts) were selected. The addition of bevacizumab to 1st line chemotherapy significantly increased both PFS (although with significant heterogeneity) and OS over exclusive chemotherapy by 17.1{\%} and 8.6{\%} (NNT 6 and 12), regardless of the study setting (non significant interaction between phase II and III). The chance to improve PR was significantly increased by 6.5{\%} (NNT 15), with a trend for ORR. The risk of hypertension was significantly increased by 6.2{\%} (NNH 16). According to the meta-regression analysis, female gender and rectal primary site were significant predictors for PFS benefit. Conclusions: Notwithstanding all the concerns related to costs and the significant HTN risk, the significant outcome improvement provided by bevacizumab in first-line treatment for unselected advanced colorectal cancer patients, should be considered when choosing the appropriate up-front therapy.",
author = "Fotios Loupakis and Emilio Bria and Vanja Vaccaro and Federica Cuppone and Michele Milella and Paolo Carlini and Chiara Cremolini and Lisa Salvatore and Alfredo Falcone and Paola Muti and Isabella Sperduti and Diana Giannarelli and Francesco Cognetti",
year = "2010",
month = "5",
day = "26",
doi = "10.1186/1756-9966-29-58",
language = "English",
pages = "58",
journal = "Journal of Experimental and Clinical Cancer Research",
issn = "0392-9078",
publisher = "BioMed Central Ltd.",

}

TY - JOUR

T1 - Magnitude of benefit of the addition of bevacizumab to first-line chemotherapy for metastatic colorectal cancer

T2 - Meta-analysis of randomized clinical trials

AU - Loupakis, Fotios

AU - Bria, Emilio

AU - Vaccaro, Vanja

AU - Cuppone, Federica

AU - Milella, Michele

AU - Carlini, Paolo

AU - Cremolini, Chiara

AU - Salvatore, Lisa

AU - Falcone, Alfredo

AU - Muti, Paola

AU - Sperduti, Isabella

AU - Giannarelli, Diana

AU - Cognetti, Francesco

PY - 2010/5/26

Y1 - 2010/5/26

N2 - Background: Although the addition of bevacizumab to 1st line chemotherapy provides a significant survival benefit for advanced colorectal cancer, the magnitudes of both advantages and toxicities have not been extensively investigated. Methods: A literature-based meta-analysis was conducted; Hazard Ratios were extracted from randomized trials for primary end-points (Progression Free Survival, PFS, Overall Survival OS). The log of event-based risk ratio were derived for secondary endpoints (objective/partial response rate, ORR/PR; severe hypertension, bleeding and proteinuria). Absolute differences and the number needed to treat/harm (NNT/NNH) were calculated. A meta-regression analysis with clinical predictors and a sensitivity analysis according to the trial phase-design were conducted as well. Results: Five trials (2,728 pts) were selected. The addition of bevacizumab to 1st line chemotherapy significantly increased both PFS (although with significant heterogeneity) and OS over exclusive chemotherapy by 17.1% and 8.6% (NNT 6 and 12), regardless of the study setting (non significant interaction between phase II and III). The chance to improve PR was significantly increased by 6.5% (NNT 15), with a trend for ORR. The risk of hypertension was significantly increased by 6.2% (NNH 16). According to the meta-regression analysis, female gender and rectal primary site were significant predictors for PFS benefit. Conclusions: Notwithstanding all the concerns related to costs and the significant HTN risk, the significant outcome improvement provided by bevacizumab in first-line treatment for unselected advanced colorectal cancer patients, should be considered when choosing the appropriate up-front therapy.

AB - Background: Although the addition of bevacizumab to 1st line chemotherapy provides a significant survival benefit for advanced colorectal cancer, the magnitudes of both advantages and toxicities have not been extensively investigated. Methods: A literature-based meta-analysis was conducted; Hazard Ratios were extracted from randomized trials for primary end-points (Progression Free Survival, PFS, Overall Survival OS). The log of event-based risk ratio were derived for secondary endpoints (objective/partial response rate, ORR/PR; severe hypertension, bleeding and proteinuria). Absolute differences and the number needed to treat/harm (NNT/NNH) were calculated. A meta-regression analysis with clinical predictors and a sensitivity analysis according to the trial phase-design were conducted as well. Results: Five trials (2,728 pts) were selected. The addition of bevacizumab to 1st line chemotherapy significantly increased both PFS (although with significant heterogeneity) and OS over exclusive chemotherapy by 17.1% and 8.6% (NNT 6 and 12), regardless of the study setting (non significant interaction between phase II and III). The chance to improve PR was significantly increased by 6.5% (NNT 15), with a trend for ORR. The risk of hypertension was significantly increased by 6.2% (NNH 16). According to the meta-regression analysis, female gender and rectal primary site were significant predictors for PFS benefit. Conclusions: Notwithstanding all the concerns related to costs and the significant HTN risk, the significant outcome improvement provided by bevacizumab in first-line treatment for unselected advanced colorectal cancer patients, should be considered when choosing the appropriate up-front therapy.

UR - http://www.scopus.com/inward/record.url?scp=77952591439&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77952591439&partnerID=8YFLogxK

U2 - 10.1186/1756-9966-29-58

DO - 10.1186/1756-9966-29-58

M3 - Article

C2 - 20504361

AN - SCOPUS:77952591439

SP - 58

JO - Journal of Experimental and Clinical Cancer Research

JF - Journal of Experimental and Clinical Cancer Research

SN - 0392-9078

ER -